INTRODUCTION:Critically ill patients experience high levels of psychological distress; however, the recognition and management of psychological distress in the intensive care unit (ICU) remain underexplored. A concept analysis of psychological distress exists for some patient populations but none in critical care. The aim of this concept analysis was to clarify the contextual character of psychological distress in ICU patients, thereby improving recognition and management practices. METHODS:Rodgers' evolutionary approach aided a deeper examination of psychological distress in the critical care literature, identifying its surrogate terms, related concepts, attributes, antecedents, consequences, and implications for nursing practice and scholarship. Databases searched included CINAHL, PsycINFO, and MEDLINE. Additional searches were performed in Google Scholar and through citation chaining of relevant articles. A coding sheet was used to organise ideas and phrases from the interdisciplinary health literature for inductive analysis. RESULTS:A total of 35 articles were included in the analysis, based on data saturation. The interdisciplinary literature revealed two surrogate terms (emotional distress and acute ICU psychological stress), one related concept (distress), four antecedents (impaired adaptation to stressors, ICU context of care, demographic and coping skills, and social support systems), and four defining attributes (traumatisation and acute affective reaction, distorted cognitive appraisal, feelings of dehumanisation and disconnection, and affecting the patient-family dyad). Consequences of the concept include chronic or long-term psychological distress, post-intensive care syndrome, poor health-related quality of life, and psychosocial functioning. CONCLUSIONS:Psychological distress in critical care may partially be a social and structural consequence of increased pace of care in the ICU. Critical care patients and survivors could be evaluated for psychological distress and be referred to a psychologist for counselling if needed. This paper provides a novel understanding of psychological distress in critical care, highlighting its unique features and the necessity for an interdisciplinary approach to achieving patient emotional safety. These insights lay the foundation for future research and policy development in critical care settings. REGISTRATION:There is no study registration number.

OBJECTIVE:This study aimed to characterize cannabis product choices (cannabinoid content and formulation) among patients with rheumatologic conditions and their associations with patient factors, patient-reported perceived side effects, and positive impacts. METHODS:An online survey (delivered from March to November 2022) was distributed by Alberta Health Services to patients with rheumatologic conditions in Alberta. Correlation matrices were used to analyze associations between cannabinoid content and formulations reportedly used with patient factors and patient-reported outcomes. Efficacy outcomes (eg, pain, sleep, mood) were grouped into a composite positive impact score, and side effects were grouped into central nervous system-activating, dampening, and sensory effects. RESULTS:Data from 1,436 respondents who indicated cannabis use and provided information on their rheumatologic condition, cannabinoid content, and formulations that they use were analyzed. Tetrahydrocannabinol (THC)-cannabidiol (CBD)-balanced products were associated with higher positive impact scores (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.18-2.63). THC-dominant products were also associated with high dampening (aOR 1.85, 95% CI 1.16-2.98) and sensory effects (aOR 2.16, 95% CI 1.27-3.70). Dried cannabis and edibles were associated with higher positive impact scores (dried cannabis: aOR 1.86, 95% CI 1.07-3.23; edibles: aOR 2.18, 95% CI 1.41-3.37). Dried cannabis was also associated with high dampening (aOR 1.98, 95% CI 1.19-3.27) and sensory effects (aOR 3.05, 95% CI 1.67-5.58). Cannabis product choice varied by age, gender, comorbidities, prior cannabis experience, frequency of use, reasons for use, access to cannabis prescription, and source of cannabis information. CONCLUSION:There is significant variability in cannabis products used by patients with rheumatologic conditions, who are influenced by patient-specific factors. Balancing THC and CBD content may facilitate positive impact while lowering the risk for side effects. Dried cannabis may pose more side effects compared to other formulations.

BACKGROUND:Long-term care (LTC) nurses are well positioned to support deprescribing given their integral role in resident care. However, there are numerous challenges to nurse involvement in deprescribing and limited research on supports to improve participation. OBJECTIVES:The objective of this study is to explore nurses' perspectives on deprescribing in LTC and identify supports that may improve their involvement. METHODS:In this qualitative descriptive study, progressive group discussions were conducted with 32 nurses at two LTC care facilities in Edmonton, Canada. Participants included registered nurses in clinical and leadership roles, licensed practical nurses and nurse practitioners. Discussions were audio-recorded, transcribed, deidentified and analysed using qualitative content analysis. FINDINGS:Four themes emerged, primarily reflecting the challenges to nurses effectively participating in deprescribing: (1) variation in deprescribing knowledge, attitudes and experience; (2) discomfort with the go-between role in family communication; (3) workload and time constraints; and (4) lack of practical supports. Suggested supports included point-of-care scripts, accessible on-unit deprescribing resources and incorporation of deprescribing into routine staff education. CONCLUSIONS:Although LTC nurses face challenges in deprescribing participation, they also identified practical supports to improve their involvement within the existing organizational structure. Future research should evaluate the impact of these supports on nurse participation and deprescribing outcomes.

Background An ethnocultural group is defined by shared characteristics such as country of origin, ethnicity, cultural traditions, or physical traits. Low vaccine coverage and increased incidence of vaccine-preventable diseases (VPDs) have been identified within some ethnocultural groups in Canada. We explored how intersections of ethnocultural identity and social location influenced perceptions about routine childhood vaccination and access to services during the COVID-19 pandemic, among racialized minority, newcomer, Indigenous, and language minority parents. Methods. Using a qualitative descriptive approach, we conducted semi-structured virtual interviews with parents of children ≤ 11 years of age. Participants were from 6 provinces, and self-identified with ethnocultural groups known to be at risk for experiencing vaccination inequities. Participants were asked to describe their ethnocultural identity, social location, and vaccination experiences within and, if applicable, outside of Canada, and contextualize how these influenced routine childhood vaccination during the pandemic. Analysis focused on emerging themes and utilized intersectionality theory. Results. Of the 17 participants, 4 self-identified as Indigenous, 11 primarily spoke minority languages, and 13 immigrated to Canada from outside of North America. Themes included: (1) newcomers found Canadian childhood vaccination accessible, although unfamiliarity with vaccine schedules and processes created uncertainty; (2) ethnocultural diversity was a protective factor against racialized minority discrimination; (3) vaccination inclusivity consisted of normalization and socialization processes, and was more than just a convenient ‘location’; and (4) polarized perceptions placed high importance on routine vaccines but increased hesitancy towards influenza and COVID-19 vaccines for children. Conclusions Our findings suggest that previous social and cultural perceptions of vaccination and experiences with VPDs shaped parents' positive perceptions and acceptance of routine vaccines for their children. Canada’s multiculturalism fosters respectful and inclusive services.

This study explored the social organization of Psychiatric Mental Health Nurse Practitioners' (PMHNPs') practice in community mental health care settings. Using institutional ethnography (IE), we examined the everyday work practices of PMHNPs to uncover the ruling relations that govern their work with patients with serious mental illness who live within conditions of poverty, violence, houselessness, and discrimination. Nine PMHNPs from outpatient community mental health clinics in a large California city participated in the study. Data collection included in-depth interviews, clinic observations, and analysis of relevant clinical and organizational texts. The analysis revealed how the mental health system's electronic health record (EHR) organizes PMHNPs' work by time, diagnosis, and medication to align their patient care with billing requirements. The Specialty Mental Health Services Medi-Cal Billing Manual and the DSM-5-TR serve as key governing texts that dictate clinical documentation standards and prioritize diagnosis and medication in the interest of revenue generation. At the same time, only some of the time spent on this work is reimbursable. The EHR organizes an institutional circuit focused on billing, which is often at odds with patients' embodied lives, experiences, and needs. PMHNPs must then mediate between this ruling relation and what they know patients need. This study contributes to the literature on the social organization of mental health care in support of advocating for policy reforms that recognize the comprehensive needs of individuals with serious mental illnesses.

AIM(S):To clarify the concept of preconception care and develop a precise and inclusive definition to improve its implementation and impact on reproductive health outcomes. DESIGN:This concept analysis paper employs Rodgers' evolutionary method to analyse the concept of preconception care, examining its historical evolution, attributes, antecedents and consequences. METHODS:A comprehensive literature review was conducted using databases such as Cumulative Index to Nursing and Allied Health Literature, Scopus, MEDLINE and Google Scholar, covering publications from 2012 to 2024. Data extraction involved identifying surrogate and related terms, attributes, antecedents and consequences of preconception care. A total of 1520 publications were retrieved, with 166 meeting eligibility criteria. Using systematic random sampling, 40 articles were selected for in-depth analysis. RESULTS:The analysis revealed that preconception care encompasses several attributes: period-related (biological, individual, public health and intergenerational), target population-related (individual, public and intergenerational) and pathway-related (universal, targeted and comprehensive). Antecedents include desires for a healthy baby and family planning decisions. Consequently, it improves pregnancy outcomes and health equity and enhances community and intergenerational health. The proposed operational definition highlights preconception care as a proactive strategy to optimise health before pregnancy through targeted and inclusive interventions. CONCLUSION:Preconception care is a dynamic and multifaceted process that extends from immediate preconception periods to long-term health considerations. Addressing diverse needs and effectively improving health outcomes requires a tailored approach considering individual, public and intergenerational perspectives. IMPLICATIONS FOR PROFESSIONS AND PATIENT CARE:A transparent and inclusive definition of preconception care will enable healthcare professionals, particularly nurses, to deliver more effective, culturally sensitive and equitable care. It will support advocacy for policy changes, resource allocation and educational initiatives to enhance preconception health. IMPACT:Addressing preconception care's complexities and diverse needs will foster a more comprehensive understanding and implementation of preconception care, ultimately improving reproductive health outcomes and promoting health equity across generations. PATIENT OR PUBLIC CONTRIBUTION:As this concept analysis was derived from published articles, patients or the public were not involved in the study's design, conduct or reporting.

Mental illness represents a substantial global public health crisis, marked by high prevalence, significant economic costs, and profound impacts on individuals’ lives. Institutional ethnography (IE) is an approach to qualitative public health research that offers a methodologically rigorous way of addressing complex social problems. IE differs from many other qualitative research methods in its materialist, social ontology, which guides researchers to reveal and explicate the ruling relations that organize everyday life and which work against the interests of people at the standpoint location. Rather than focusing on populations, IE researchers focus on investigating processes and protocols that are activated locally through people’s everyday work and trace up into translocal ruling relations. The focus on social organization and empirically grounded analysis set IE apart from other qualitative methods and allow for different knowledge to be gained. IE is a methodology concerned with illuminating the voices of the marginalized and vulnerable and with increasing health equity by showing, as a first step, precisely how, when, and where systems are organized to benefit powerful institutional interests rather than people. The empirically grounded insights gained from IE research can inform the development of more equitable and responsive ways to run clinics that rely on the knowledge of those people who operate and use the services. They can also be used to develop policy frameworks that direct ongoing attention to the subjectivities of those whose work is implicated in planned health care reforms. We draw on our recent public health research to share our experiences of using IE methods and provide practical insights relating to each stage of the research process that may be valuable to novice researchers.

Purpose of Review: Depression and depressive symptoms are prevalent and disproportionally high among individuals undergoing hemodialysis. Depression has emerged as the most common mental health issue within the hemodialysis community. However, the characteristics related to sex and gender among individuals receiving hemodialysis and experiencing depression and depressive symptoms are not well known. The purpose of this review is to describe the characteristics of sex and/or gender in adults receiving hemodialysis and living with depression or depressive symptoms. Sources of Information: Electronic databases included Cochrane, Embase, Medline, CINAHL, and PsycINFO, when searching for peer-reviewed literature. Methods: Systematic searches were conducted to identify peer-reviewed literature related to the characteristics of sex and gender factors among people treated with hemodialysis worldwide. Two reviewers screened 4036 titles, abstracts, and 37 full texts. Discrepancies were resolved by these same reviewers. Data from the studies that met the inclusion criteria were extracted according to the study objectives; characteristics of sex and/or gender were further analyzed by similarities and differences. Key Findings: We identified 25 peer-reviewed articles that addressed the characteristics of sex and/or gender. Of the 25 articles, 7 reported gender differences, 4 reported gender similarities, 13 reported sex differences, and 1 reported sex similarities in individuals with depression or depressive symptoms treated with hemodialysis. We found more differences than similarities in sex and gender related to depression among individuals with kidney failure undergoing hemodialysis, with notably higher rates of depressive symptoms observed in female individuals (sex) and women (gender). However, findings alert us to the possibility that due to contextual influences, male individuals may express depressive symptoms in different ways. There was substantial heterogeneity among the included papers, with nearly half of the studies conducted in Asia. In 76% of the studies, sex and gender were used interchangeably without a clear distinction; we used the term or the intention of the term used by the authors in their studies to inform our analysis. Studies further lacked any representation of gender-diverse individuals. Limitations: It is possible that additional literature on depression in relation to the characteristics of sex and gender among adults undergoing home-based hemodialysis exists; our systematic search was limited to in-center and satellite settings. Our study primarily investigated populations in Asia. It is important to note that there may have been misclassification issues with the terms “sex” and “gender.”

Depression prevalence rates are high in individuals with end stage kidney disease treated with hemodialysis. However, nephrology nursing knowledge about the care of patients with depression is not well studied. The purpose of this review was to explore the knowledge nephrology nurses utilize in the care of patients on hemodialysis who are living with depression. We performed an exploration of MEDLINE, EMBASE, PsychINFO, CINAHL, Cochrane Central Register of Controlled Trials, and Scopus to identify eligible studies. Nine studies were included, and we determined that nephrology nurses' knowledge is informed by the nursing process, primarily in assessment and intervention/ management, with minimal explicit description of theory in hemodialysis and depression care.

Recent discourse emphasizes the need to integrate social and structural determinants of health-such as poverty, violence, houselessness, and discrimination-into mental health care service design and delivery. This study investigates how psychiatric-mental health nurse practitioners (PMHNPs) navigate the conflicting demands of an efficiently organized clinic and the realities of patients experiencing chronic mental illness along with structural adversity. Using an institutional ethnographic approach, this research focused on the everyday work practices of nine PMHNPs in outpatient community mental health clinics in a major American city. The findings revealed disjunctures within two powerful discourses related to patient access to care that circulate in mental health settings: (1) "every door is an open door," and (2) "meeting people where they are." PMHNPs believe in the values promoted by the rhetoric while also being required to work outside institutional structures to meet real patient needs. By illustrating how the institutional coordination expected to improve health systems overlooks PMHNPs' expert knowledge, we highlight how addressing the "structural determinants of health" in clinical care for people with serious mental illnesses remains an ideological aspiration. We call for a reevaluation of mental health care practices and systemic transformation through the informed, ground-level interventions of PMHNPs.

Chronic pain is often a primary symptom for rheumatologic conditions. With the legalization of cannabis in Canada and many other jurisdictions, the use of cannabis is increasing. A risk assessment tool can guide clinicians and patients on the potential risk associated with cannabis use for alleviating the symptoms of rheumatologic conditions. The aim of this Delphi study is to identify key elements for the development of a risk assessment tool for the safe use of cannabis for people with rheumatologic disease. International experts representing different healthcare professions in rheumatology were invited through targeted recruitment. The research team developed statements for the Delphi consensus based on literature review and focus groups. The number of rounds was dependent on when consensus was reached. The level of agreement was set at 75

In this article, we aimed to evaluate the utility of critical posthumanism for nurses interested in planetary health-a growing area of study that requires a decentering of the human, and environmental justice considerations. We used Chinn and colleagues' method to describe and critically reflect on critical posthumanism, extending the theory analysis method to include a wide range of academic and video sources. We found that critical posthumanism is like a double-edged sword: It provides a lens through which to transcend human-centric approaches to healthcare but is marred by its lack of clarity and inaccessibility. We argue critical posthumanism can be adapted to enhance its potential at the intersection of nursing and planetary health. An analysis of critical posthumanism is followed by a discussion framed by five ways of knowing in nursing, highlighting real-world examples of how critical posthumanism can aid nurses in dealing with planetary health concerns. By exploring the intersections of critical posthumanism with nursing knowledge, we demonstrate how critical posthumanism can enable nurses to comprehend and tackle environmental issues intricately linked to human health.

IntroductionShared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology.ObjectiveTo describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology.MethodsBibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language.ResultsOf the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53%). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16%), Informed Medical Decision Foundation elements (3/36, 8%), edutainment principles (2/36, 5.5%), and others (e.g. DISCERN and MARKOV Model) (9/31,29%). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39%), acceptability and knowledge (7/46, 15%), and the preparation for decision-making scale (5/46,11%).ConclusionFor better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.

Introduction: New faculty's experiences in a tenure track position have been reported to be stressful and retention of new faculty can be difficult in the competitive academic climate. However, research literature on this topic is predominantly American based. A focused ethnography was undertaken to understand the experience of new PhD-prepared nursing faculty in Canada more fully.

BACKGROUND:Creating a research program is a critical requirement for new PhD-prepared tenure-track nursing faculty in Canada. PURPOSE:The purpose of this article is to present key findings of new faculty members focusing on facilitators and barriers to development of their research program. METHOD:We conducted focused ethnography research examining the experience of 17 new faculty members from across Canada. RESULTS:The following themes were identified: teaching release, preparation from PhD program, intense feelings, supports and processes, mentoring, obtaining grants, and effects of the COVID-19 pandemic. CONCLUSIONS:Implications for practice include identifying ways to facilitate faculty retention as they develop their research program. This research will be of interest to deans of nursing and new faculty members.